Analysis of the Existence of Insurance Fraud in the Case of Insurance Claim Payment Failure and the Legal Protection for Insurance Clients in the Insurance Company’s Failure to Pay Claims



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Submitted Nov 21, 2022
Published Dec 27, 2022
10.24018/ejpolitics.2022.1.5.50

Abstract viewed = 577 times

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Insurance is one of people’s needs as a protection from the loss-causing risks. Based on the insurable interest, people then have an insurance agreement. The legal relation between an insurance company and the insured is based on a written agreement called a policy. In reality, not all claims can be done well. Insurance companies often fail to fulfill its obligation (payment failure), which is caused by several factors, including the allegation of frauds. This research is going to discuss the existence of insurance fraud as a factor in the case of payment failure of an insurance claim. The research employs a normative juridical method using the secondary data in the forms of primary legal materials such as relevant regulations, as well as secondary legal materials such as legal books and literature. The research uses legislation and conceptual approaches. The fraud factor is indicated if the element of intent can be proven when, in doing the transaction, the insurance company’s board has abused their authority, and when the transaction is proven to have influenced the company’s financial health.

Keywords: insurance, fraud, legal protection, payment failure.

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